Effectiveness of Liposomal Bupivacaine for Postoperative Analgesia After Thoracic Surgery: A Propensity Score-matched...

Given that liposomal bupivacaine (LB) is not currently approved for thoracic surgery, this study evaluated postoperative analgesia after thoracic procedures.

This retrospective cohort study with propensity score matching yielded 99 matched pairs. Patients were grouped by receipt of a postoperative ultrasound-guided serratus anterior plane block with LB plus standard care versus standard care alone. The primary outcome was the area under the curve (AUC) for pain scores over the first 0 to 72 postoperative hours. Secondary endpoints included verbal response scale pain scores, opioid consumption, quality of recovery, and hospital length of stay. Statistical significance was defined as P < 0.05.

Baseline characteristics were well balanced after matching. The LB group had a lower 0- to 72-hour pain AUC (110 ± 48 vs. 185 ± 67; P < 0.01), exceeding the prespecified threshold for clinical relevance (at least a 10% reduction), and lower early postoperative pain scores. Opioid consumption was reduced at 24 and 48 hours (both P < 0.01). Quality of recovery scores were higher at 24, 48, and 72 hours, with the 24-hour difference meeting the minimal clinically important difference. Postoperative nausea and vomiting were less frequent from 6 to 24 hours; length of stay did not differ.

Perioperative regional block with LB was associated with reduced pain burden and opioid use after thoracic surgery. Prospective, multicenter randomized trials with longer follow-up and health economic evaluations are needed.